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Nursing Shortage

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Health care plays a remarkable role in a country’s economy as well as in the quality of life for its citizens. Nursing is a critical component of both fronts. As an economic sector, healthcare is generally identified as the second largest nongovernment employer. Therefore, nursing shortage is one of the most crucial issues of health care today.

According to the recent reports of the Legislative Analyst’s Office of California (2007), the number of RNs does not correspond to the current demands of the healthcare industry. There has been a growing concern that the potential mismatch between the demand for RNs and the size of the RN force will affect the delivery of essential healthcare services to the public. Many studies have warned that the need for RNs is going to increase due to the growing rates of ageing population and general lack of qualified nurses who are needed to care for individual patients as well as the population en masse. RNs are an essential part of the healthcare delivery team. They work in both public and private sectors of the healthcare industry in various clinical settings including hospitals, medical offices, clinics, qualified nursing facilities, and home care environments. Healthcare service providers hire the RN. They work primarily in hospitals. The RN’s main responsibilities are to provide direct care to patients. 

Today's current shortage is driven by unprecedented social, economic, and demographic factors. According to Mee and Robinson (2003), today's nursing shortage is unlike any shortage experienced before. Mee and Robinson (2003) stated, “Labor and population trends are unique today and are causing massive disruptions in the supply of nurses at the same time the need for nursing care has begun to skyrocket” (p. 52). Mee and Robinson (2003) noted that two population groups, patients and nurses, were moving in opposite directions. Many authors pointed out that fewer individuals choose nursing since other professions are available to women now who were not available to them in the past. As noted by a nurse-researcher, Peter Buerhaus (Mee & Robinson, 2003), a primary factor leading to this nursing shortage is the declining interest in nursing among women who now have many career options when compared to the past. In addition, healthcare institutions were restructured and cut costs during the 1990s. Consequently, healthcare institutions were downsized, and many registered nurses lost positions within their organizations. The remaining staff had to pick up the burden of having more patients to care for and more tasks to do. This did not help; it only led to more nurses leaving their jobs.

The emergency of the current shortage after a period of surplus should not be a surprise to nurse administrators or economists. Moreover, the nursing shortages of the 1970s, 80s, and 90s never dissipated; instead, they spilled over into the present nursing shortage. Many factors contribute to the nursing shortage, including changes in nurse demographics, patient demographics, healthcare marketplace, and regulatory policies. No single factor was found to be a cause for the nursing shortage of today or those of the past. Buerhaus (2005) argues that multiple factors led to the current nursing shortage in comparison with shortages of the past.

The nursing shortage is going to continue for a long time. According to Schwarz (2003), the Department of Health and Human Services (DHHS) projected that the current shortage would worsen over the next two decades as RNs retired and fewer were expected to enter the profession. In addition to this startling revelation by the DHHS, according to the ANA (2004), “the nation is facing an impending shortages of nurses that is expected to peak by 2020” (para 1). Schwarz (2003) continued to note that this was a problem of simple supply and demand. The country will experience a growth in population, including a large number of the elderly, thanks to better education, improved healthcare services, and medical advancement.

As reported by Schwarz (2003) and Mee and Robinson (2003), each nursing shortage is unique; however, solutions that have been used in the past would not be applicable to today's shortage. Mee and Robinson (2003) pointed out that “quick fixes such as hiring bonuses and educational reimbursements may help in the short run, yet they will not solve the underlying issues at hand” (p. 53). The research suggests that the demand for nurses will continue to grow due to the aging population and increased life expectancy noted in other studies. Between 2010 and 2020, the portion of the population aged 65 or older will increase from approximately 13% to 20% (Young, 2003). Young (2003) noted that this represented an increase of approximately 30 million people in that age group. These numbers are of particular concern to all countries worldwide. 

According to the research conducted by Young (2003), the number of jobs for the registered nurses is expected to climb to 84,410 by 2008. Young (2003) further noted that due to this increase, there would also be an increase in bedside positions, which led to an annual number of new openings of 2,270 from 2002 to 2008. Young (2003) claimed that approximately half of this number would be needed to replace retiring nurses and half to meet the increased demand for healthcare services created by the aging population and increased life expectancy.

In a 2004 survey, Buerhaus et al. (2005) showed that nurses surveyed exhibited less of a gap between those issues surrounding the supply and demand issues of respondents in 2002. Fewer nurses in 2004 perceived salary and benefits as the main cause of the shortage than in 2002 (41% vs. 58%). Lastly, while at least half of the nurses surveyed perceived most recruitment and retention strategies to be valuable, just more than half of the nurses observed one retention strategy: mentoring programs for new graduates (Buerhaus et al., 2005, p. 61).

According to Buerhaus et al. (2005), the issue of nursing shortage is gradually being resolved. Notwithstanding this, the negative consequences of the shortage for hospitals are obvious as the majority of RNs note reductions of hospital beds, an increase in the time that patients spend waiting for surgery or tests, delays in discharges as well as increased number of complaints about nurses. In addition to these issues, nurses also perceive the shortage to be a major problem. Nurses hear more patients’ complaints and detect early patients’ complications more, while they also maintain patients’ safety and quality of care, feeling they are spending less time with their patients and taking less time for themselves (Buerhaus et al., 2005).

Buerhaus et al. (2005) claimed that the nursing shortage affected the quality and safety of patient care in hospitals. Until the shortage of nurses is resolved, the goals of such organizations as the Institute of Medicine (IOM), Agency for Healthcare Research and Quality (AHRQ), National Quality Forum (NQF), Institute of Healthcare Improvement (IHI), Joint Commission on Accreditation of Healthcare Organization (JCAHO), Centers for Medicare and Medicaid Services (CMS) and others will not be realized (Buerhaus et al., 2005). Solving the nursing shortage will take time, effort, and commitments on the part all stakeholders involved. All healthcare personnel and stakeholders need to work together to provide safe, efficient, and quality care to all patients. In doing so, the shortage will lessen and the size of nursing workforce will increase. All concerned parties need to contribute and work together to design alternative solutions in order to maintain the quality of care during the shortages as the nursing workforce goes through a period of transition.

Desired changes in the nursing workforce are closely connected with necessary changes in the nursing academia, which consist of clinical training needs, standardization, educational levels, curriculum, and support. Today, the shortage of nursing faculty is interwoven with the nursing shortage occurring within the United States and in other countries. Due to the shortage of faculty, nursing schools are limiting the number of student enrolments. There will be a decrease in the number of graduates entering the workforce as well. As seen in other pieces of literature, many opportunities and choices are being offered to nurses, and this may therefore decrease the overall number of nurses choosing to enter graduate studies and academic careers (Hinshaw, 2001). This will compound the shortage of nursing faculty even more.

The shortage of nursing faculty will be detrimental for the sustaining of nursing knowledge. With a decreasing number of nurses entering the field of nursing research, along with the retiring of senior nurse researchers, the development of the field of nursing's knowledge base may be limited. This will curtail the number of educational leaders within organizations who are able to help design health policy in their states, on a national level, and in the international arenas.

The increasing complexity of health care delivery, a great variety of chronic and incurable diseases, high rates of mortality and morbidity, absence of appropriate health insurance, and shortage of mid-level medical professionals are crucial issues of health care delivery systems worldwide. These facts and statistical data provided by the World Health Organization and the US Centers for Disease Control and Prevention directly testify to inefficacy of the existing healthcare delivery system.

The delivery of health care should correspond to a changing paradigm of medicine, be socially available, cost-effective and guarantee high-quality medical aid for the whole population. However, health care organizations and health care delivery systems are affected by the officially registered shortage of NPs, as well as other medical professionals, increasing rates of individuals without health insurance, complicated clinical practice in the underserved communities and remote areas, “the imbalance between the supply of and demand for health services”, problems in “coordination and communication across providers and settings” and inappropriate payments for health care providers’ services (United States Government Accountability Office, 2010). The above-mentioned problems aggravate practices of health care delivery in general and medical organizations in particular. Therefore, in order to improve the current and future medical aid provision, health care delivery systems should be redesigned and legally standardized by empowered officials and governmental bodies worldwide. 

Providing basic medical aid for a wide range of patients in various health care settings, Nurse Practitioners (NPs) have become a vital part of the team which promotes the delivery of efficient high-quality patient care. They perform a great number of therapeutic procedures in varied health care organizations “using guidelines, pathways, protocols, checklists, and related tools” (Tollen & Crosson, 2010, p. 47). However, their medical interventions should be supervised by physicians. Demand for officially expanded powers of Nurse Practitioners are the result of the change in complexity of care required by patients, clientele suffering from numerous diseases, and the dramatic physicians’ shortage.

NPs’ empowerment is one of the most influential factors contributing to efficient health care delivery. Being empowered at work, NPs perform their duties and fulfil responsibilities more effectively and, thus, promote efficacy of health care. However, today, employee empowerment initiatives do not correspond to the levels of empowerment intended due to specific economic conditions, as well as organisational environments, contextual factors and strategies. Therefore, it is important for HR managers of clinical settings, administrators, and organisational scholars to identify deliberate strategies to promote and facilitate NPs’ empowerment. 

Economic factors influence doctors’ decisions to leave rural areas for practice in urban healthcare establishments. Thus, substituting doctors, Nurse Practitioners often conduct a variety of medical interventions without physicians’ supervision unlike their colleagues in metropolitan areas. Rural residents are generally characterized by higher rates of chronic diseases and occupational injuries, frequent breathing disorders caused by agricultural chemicals, and lower levels of health insurance presence. 

Distance and time are the critical factors, which influence essentially on quality, volume, timeliness, and cost of medical aid. In order to deliver medical services to patients, who are immobilized, live in remote places or have chronic diseases, NPs use telecommunication technologies. They lead consultations, educate relatives of the sick, assist in examinations, assess, diagnose, and monitor patients online. To correspond to the population requirements in medical aid delivery a rural clinical setting should be computerized, supplied with state-of-the-art equipment, and conveniently located. Thus, NPs should be skillful, well trained, and constantly developing their knowledge as professionals, which stipulates an increase in demands for NPs’ training and education.

The recent studies highlight the significance of the nursing shortage in health care systems of developing countries. According to the data of the World Health Organisation, these countries are facing a critical shortage of human resources in the health care sector (WHO, 2008). Due to the current severe physician shortage in the developing countries such as the Marshall Islands, the Caribbean countries, India, and an overwhelming majority of African counties, mid-level providers are widely utilized there. Substituting physicians, they provide a broad array of health care services (Chilopora et al., 2007). According to the published results of the quantitative research, which was conducted at district hospitals in Malawi, there is no significant difference in the outcome of operations performed by either physicians or Nurse Practitioners providers (Chilopora et al., 2007).

Summing up, the nursing profession is in crisis partly because experienced Nurse Practitioners retire or finding other careers; and this job is not attractive enough to draw in sufficient numbers of new nurses. The delivery of health care should correspond to a changing paradigm of medicine, be socially available, cost-effective and guarantee high-quality medical aid for all population. However, health care organizations and health care delivery systems are affected by the officially registered shortage of NPs, as well as other medical professionals, growing rates of individuals without health insurance, complicated clinical practice in the underserved communities and remote areas, “the imbalance between the supply of and demand for health services”, problems in “coordination and communication across providers and settings” and inappropriate payments for health care providers’ services (United States Government Accountability Office, 2010). The above-mentioned problems associated with the shortage of nursing aggravate practices of health care delivery in general and medical organizations in particular. Therefore, in order to improve the current and future medical aid provision, health care delivery systems should be redesigned and legally standardized by empowered officials and governmental bodies worldwide.

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